EDITORIAL: What price life? Pushback by OHSU's Brian Druker against high drug costs should prod review

Oregonian (Portland, OR)

05-01-13

April 29--It's one thing to be told you have cancer and a few years to live.
It's entirely another to be told Wait, you do have cancer, but a medication that
will extend your life by several years is available for $100,000 a year.

Reasonable people would scoff at the sum, even though insurance might reduce the
out-of-pocket co-pay to, say, $1,400 a month -- for many, another mortgage. But
being told you'll die is calamitous on its face and does not produce entirely
reasonable behavior. Doing anything to gain those precious years, including
selling one's house or canceling retirement, might look necessary if not sane.
That's to say nothing of those without insurance or a house or a planned
retirement.

Stratospheric drug prices are pushing a lot of ill people into impossible
situations -- and woe betide the patient who chooses a less-promising, one-time
surgery to save money. The ball-and-chain consequence to everyone, meanwhile, is
that sky-high drug prices threaten to topple a health care system whose costs
already are out of control -- hence, in part, Oregon's efforts at cutting costs
by changing the model of health care delivery for folks on the Oregon Health
Plan.

More than 100 cancer specialists published a paper last week in the hematologic
journal Blood, arguing cancer drugs cost too much money and that high prices
threaten patients and the health care system. One name among the specialists
stood out: Brian Druker, director of the Knight Cancer Institute at Oregon
Health & Science University.

Druker's research in the 1990s is largely responsible for bringing to market the
cancer-stopping drug Gleevec, priced in the early 2000s under $30,000 a year and
now costing about $100,000 a year. Gleevec's development, it was assumed then
and since, had made Druker a darling of the drug's maker, Novartis, which has
profited handsomely from manufacturing and marketing the drug.

In 2009, upon receiving the prestigious Lasker Award for his research
breakthroughs associated with Gleevec, Druker told The Oregonian: "We are well
on our way to making effective and non-toxic therapies a reality for all cancer
patients."

On Monday, Druker was no less optimistic but rueful about a system that creates
unbridled profits but out-of-reach prices for many: "We must have a healthy drug
industry. But the issue is this: When are you making enough money to stay in
business?"

Gleevec is now but one of several effective but expensive cancer-busting drugs.
And there are wildly expensive drugs for diseases other than cancer: A multiple
sclerosis medication is estimated to cost $50,000 a year while a new and lauded
cystic fibrosis drug approaches a whopping $200,000 a year.

A clinician as well as a researcher, Druker is palms to the sky about
prescribing to a patient the equivalent of bankruptcy. "Thank you very much," he
says of the new miracle drugs. "What would you suggest we do?"

But Druker goes on to ask: "If it currently costs $1 billion to develop a drug,
what would happen if it only cost $100 million? A large part of that $1 billion
includes numerous failures to get to a success.... As we get smarter about
targeting specific populations of patients, the number of failures should
decrease and the numbers of patients needed to show benefit should be smaller.
Large innovations should be quickly rewarded -- and this is where the U.S. Food
and Drug Administration needs to have a role."

There could be a way out, after all, though it won't happen by federal
regulation alone. The collaboration between research institutions and
pharmaceutical companies must become more efficient and agile -- and the FDA
more quickly responsive throughout -- if the sometimes extortionist pricing of
patented drugs is to be reined in.

Patients offered the option of living shouldn't have to worry whether they can
afford to. Neither should a nation have to worry whether it can afford its own
health care system.

That Druker pushes back on the prices of the lifesaving drugs he and his
colleagues help to create is exemplary. His message and the argument published
in Blood need to be heard by other-than-cancer specialists as well as
drug-makers and the Congress.

___

(c)2013 The Oregonian (Portland, Ore.)

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